Okay, stop giggling with embarrassment.  This is a serious matter.  Grownups euphemistically refer to school “bathrooms” or “restrooms.”  The kids tend to be more direct and descriptive, often referring to the “disgusting toilets” at our schools.  Whatever terms you use, the plain truth is that there is a big problem here.  Just ask your kids.  Or, ask me!

Chronic constipation is one of the most common reasons children are referred to those of us who practice pediatric gastroenterology.  The root cause varies with the age and developmental stage of the child.  For very young and pre-school children, starting solid foods or beginning toilet training can be “triggers” for constipation.

But for school-age children, a common trigger is the school bathroom.  I always ask my school-age patients if they use the bathrooms at school.  In the privacy of my office, their responses are pretty direct…and sometimes funny.

  • “Oh, no, I use the bathrooms only if I really, really have to go.”
  • “No way. The bathrooms are disgusting!”
  • “No. The toilet seats, and the floors and walls are dirty.”
  • “The toilets aren’t flushed. Or they’re backed up.  Once there was a bunch of tamales in the toilet!”
  • “There are no toilet seat covers and sometimes no toilet paper.”
  • “There is no privacy. Other kids laugh if you make noise.”

So, what do kids often do if they have to use the bathroom at school?  What do you do if you find a filthy toilet at a gas station?  You tell yourself, “I’ll just hold it a while longer.”  If this occurs often enough, kids will develop constipation, stomachaches, bloating and increased gas.  Eventually, some kids develop fecal incontinence and wind up walking around school with “poop in their pants.”  If other kids smell it, the teasing, embarrassment, and isolation often lead to behavioral problems.  And, physically, fecal incontinence can cause serious rashes and children who tell me that day-after-day they “just don’t feel well.”

What should parents do?  If your child suffers from constipation and incontinence due to avoidance of school bathrooms, try to help by having your son or daughter establish a habit of sitting on the toilet — at home — after breakfast.  Make sure the morning routine is not rushed.

In cases where school bathrooms continue to be a real problem for individual children, I’ve written prescriptions requesting that these kids be allowed to use the teachers’ or administrators’ bathrooms, where there is more privacy (and cleanliness).

Here’s something else parents can do.  Since unacceptable school bathrooms are a very common cause of constipation and other gastrointestinal problems among lots of kids, make sure your child’s school provides adequate staff and services to maintain clean toilet facilities.  Be an advocate — for more custodians, more school nurses, and more emphasis on hygiene in our schools.  Remember, school nurses are perhaps the strongest partners we have in advocating for the health and well-being of all school children.

Finally, for more information on kids and constipation, here is a good reference, and be sure to watch the video: http:www.gikids.org/content/50/en/constipation

Phyllis Agran, M.D.

Phyllis Agran, M.D.

Phyllis Agran is a practicing Orange County pediatrician, a Professor at the UC Irvine School of Medicine, and Past President of the Orange County Chapter of the American Academy of Pediatrics.Dr. Agran is a recognized national expert in pediatric injury control and prevention. She is also a member of the Irvine Unified School District's Medical Advisory Committee. Phyllis can be reached at phyllis@irvinecommunitynews.org
Phyllis Agran, M.D.